Can We Use Artificial Intelligence Cluster Analysis to Identify Patients with Metastatic Breast Cancer to the Spine at Highest Risk of Postoperative Adverse Events?

Mitchell S Fourman; Layla Siraj; Julia Duvall; Duncan C Ramsey; Rafael De La Garza Ramos; Muhamed Hadzipasic; Ian Connolly; Theresa Williamson; Ganesh M Shankar; Andrew Schoenfeld; Reza Yassari; Elie Massaad; John H Shin

doi:10.1016/j.wneu.2023.02.064

Can We Use Artificial Intelligence Cluster Analysis to Identify Patients with Metastatic Breast Cancer to the Spine at Highest Risk of Postoperative Adverse Events?

World Neurosurg. 2023 Jun:174:e26-e34. doi: 10.1016/j.wneu.2023.02.064. Epub 2023 Feb 18.

Affiliations

¹ Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA.
² Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA.
⁴ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: shin.john@mgh.harvard.edu.

PMID: 36805503
DOI: 10.1016/j.wneu.2023.02.064

Abstract

Objective: Group patients who required open surgery for metastatic breast cancer to the spine by functional level and metastatic disease characteristics to identify factors that predispose to poor outcomes.

Methods: A retrospective analysis included patients managed at 2 tertiary referral centers from 2008 to 2020. The primary outcome was a 90-day adverse event. A 2-step unsupervised cluster analysis stratified patients into cohorts using function at presentation, preoperative spine radiation, structural instability, epidural spinal cord compression (ESCC), neural deficits, and tumor location/hormone status. Comparisons were performed using χ² test and one-way analysis of variance.

Results: Five patient "clusters" were identified. High function (HIGH) had thoracic metastases and an Eastern Cooperative Oncology Group (ECOG) score of 1.0 ± 0.8. Low function/irradiated (LOW + RADS) had preoperative radiation and the lowest Karnofsky scores (56.0 ± 10.6). Estrogen receptor or progesterone receptor (ER/PR) positive patients had >90% estrogen/progesterone positivity and moderate Karnofsky scores (74.0 ± 11.5). Lumbar/noncompressive (NON-COMP) had the fewest patients with ESCC grade 2 or 3 epidural disease (42.1%, P < 0.001). Low function/neurologic deficits (LOW + NEURO) had ESCC grade 2 or 3 disease and neurologic deficits. Adverse event rates were 25.0% in the HIGH group, 73.3% in LOW + RADS, 24.0% in ER/PR, 31.6% in NON-COMP, and 60.0% in LOW + NEURO (P = 0.003).

Conclusions: Function at presentation, tumor hormone signature, radiation history, and epidural compression delineated postoperative trajectory. We believe our results can aid in expectation management and the identification of at-risk patients who may merit closer surveillance following surgical intervention.

Keywords: Breast cancer; Complications; Predictive analytics; Spine fusion; Spine metastasis; Spine surgery.

MeSH terms

Artificial Intelligence
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Cluster Analysis
Female
Humans
Leukemia, Myeloid, Acute*
Retrospective Studies
Spinal Cord Compression* / etiology
Spinal Cord Compression* / pathology
Spinal Cord Compression* / surgery
Spinal Neoplasms* / secondary